Buffalo and Erie County Workforce Development Consortium, Inc.    JOB ORDER FORM 726 Exchange Street / Suite 630 Buffalo, New York 14210 Telephone: (716) 819-9845 Fax: (716) 819-9849

EMPLOYER INFORMATION
Date		Business Name
Unemployment Registation # / Federal ID.
Street Address		Mailing Address
City		City
State		State
Zip		Zip
Telephone		Fax
Contact Person/Title
Would you like your company name available to the public on your job listing?
Yes No
Referral Method (check all that apply)
E-mail   Telephone   Fax   Mail   In Person

JOB INFORMATION

Job Title          Job Location

Number of Job Openings

Duration temporary regular seasonal   Full Time Part Time Work Days Per Week (Check all that apply) Mon. Tues. Wed. Thurs. Fri. Sat. Sun. Shift First Second Third Varies Other    Explain

If this job is temporary, how long do you expect it to last?

Education Required

Licenses / Certificates / Degrees

Experience    Years     Months

Would you accept a Trainee?        Yes No

Public Transportation Available    Yes No

Wage    Minimum Pay $ To Maximum Pay $ Per hour month year

Driver's License    Yes No    Class

Union Affiliation    Yes No

Benefits (check all that apply)

Health Insurance   Dental Insurance   Vacation   Sick Leave Holiday   Retirement/401k   Clothing Allowance    Child Care

Other hiring requirements (Check all that apply)

Own Car  Drug Screening  Medical Exam  Reference Check  Own tools Credit Check  Criminal Background Check  Abuse State Registry Check

Is any of this pay based on draw or commission at any time during employment? Yes No

Job Description Brief Explanation of Job Duties (Attach company job description if available)

Four major skills needed to perform job (in priority order)

1.

2.

3.

4.

Your business may be eligible for Tax Incentives and/or On-the-Job Training wage subsides if you hire from designated target groups. Would you like more information on this subject?     Yes No